Exploration of Nursing Care Strategies for the Management of Urinary Incontinence in Hospitalized Women

Karen A. Blanchette, BSN, RN

Disclosures

Urol Nurs. 2012;32(5):256-259. 

In This Article

Abstract and Introduction

Abstract

Urinary incontinence is a major health condition among hospitalized women. The assessment, identification, and treatment of this condition are lacking. A review of the literature was undertaken to determine the state of the science for managing this condition. Five factors that induce or exacerbate urinary incontinence were identified and are presented here.

Introduction

Urinary incontinence (UI) is the involuntary loss of urine. According to Thompson and Smith (2002), there are five types of incontinence: 1) stress, 2) urge, 3) mixed, 4) overflow, and 5) functional. Stress incontinence has been defined as the failure to hold in urine against increased abdominal pressure from activities such as coughing, sneezing, or laughing. Urge incontinence is the failure to hold in urine when experiencing the urge to void. Mixed incontinence occurs when a combination of any two types of incontinence is present – most frequently stress and urge. Overflow incontinence is when the bladder fails to empty, despite attempts to void, resulting in bladder over-distention and urinary dribbling. Overflow incontinence may also occur as a result of urinary retention due to weakened or unresponsive bladder muscles. Functional incontinence is when an individual is physically unable to reach the toilet due to physical mobility deficits or environmental barriers.

UI affects approximately 26 million Americans (Landefeld et al., 2008) and is disproportionally more prominent in women than in men, with 1 in 3 women reporting episodes of UI (Goode, Burgio, Richter, & Markland, 2010). According to Minassian, Stewart, and Wood (2008), the prevalence of UI increases with age and has been a self-reported symptom in 49.2% of adult women.

UI is common in acute care hospitals, where as many as 70% of older adult inpatients have documented incidences of UI (Landi et al., 2002). There are high economic costs associated with UI because its presence is associated with increased social isolation, falls, and admission to long-term care facilities and homecare services (Goode et al., 2010; Sampselle, Palmer, Boyington, O'Dell, & Wooldridge, 2004; Wagner & Subak, 2010). Nearly $20 billion is spent annually in the United States on the management of UI (Landefeld et al., 2008; Wagner & Subak, 2010). Ten percent of this $20 billion is allocated to routine care needs, such as laundry, skin protectants, and absorbent pads. In 2000, $5 billion was spent on managing UI in the institutionalized population, and $14 billion was spent on the community-dwelling population (Landefeld et al., 2008).

The desire to minimize episodes of UI while decreasing costs creates the need to better manage UI among those hospitalized. In the hospital setting, nursing's role in patient care allows for the opportunity to recognize urinary abnormalities that frequently go unreported, and thus, untreated. Nurses should have the knowledge to identify and manage UI in the acute care setting. However, nurses often fail to identify voiding abnormalities in their patients. One of the most cited reasons patient voiding abnormalities go unidentified is due to the nurse's lack of education of the appropriate assessment tools and management strategies (Dingwall, 2008). Further education and research are needed to identify best practice methods for managing and minimizing UI episodes among hospitalized women. To address these issues and better inform staff, a systematic review of the literature was conducted, and findings and recommendations for care from this review form the basis of this article.

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